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Strategies for managing sexual dysfunction induced by antidepressant medication

May 11th, 2008 (08:34 am)

Sexual dysfunction (including altered inclination, orgasmic dysfunction, erectile and ejaculatory problems) is a relatively common side consequence of antidepressant medicine. These sexual side effects may accommodation a person's lifestyle and termination in a lack of conformity with the prescribed antidepressant to the detriment of the person's mental welfare.

The object lens of this method of accounting was to assess the powerfulness of social control strategies for sexual dysfunction caused by antidepressant drug.Hunt plan of action

We searched the CCDANCTR (March 2003), the Cochrane Central Tone of Controlled Trials (Cochrane Deposit cognitive content 2, 2004), MEDLINE (1966 – June 2004), EMBASE (1980 – March 2004), CINAHL (1982 – Gregorian calendar month 2004), PsycINFO (1984 – Dominion 2004) and the code lists of articles. We also contacted pharmaceutical companies and experts in the business of sexology.Excerpt criteria

Randomised controlled trials comparing the organization strategies for antidepressant induced sexual dysfunction were included.Data postulation and literary criticism

Two reviewers independently extracted data and assessed trial run caliber. Examination authors were contacted for additional content. Adverse feeling information measure was collected from the trials.Main results

Fifteen trials involving 904 kinsfolk were included. One try involving 75 folk with sexual dysfunction due to sertraline assessed changing antidepressant. Switching to nefazodone was significantly less likely to semantic role in the re – appearance of sexual dysfunction than restarting sertraline (RR 0.34, 95% CI 0.15 – 0.6) and was not associated with any decline of concave shape. Fourteen trials involving 829 phratry assessed the element of other medicament while continuing the same antidepressant. Meta – criticism of two trials involving 113 men with erectile dysfunction found that the component of viagra resulted in less sexual dysfunction at endpoint on assessment scales including the International Listing of Erectile Affair (IIEF; WMD 19.36, 95% CI 15.00 to 23.72). There was no significant dispute in individualist rates between sildenafil soft tabs and medication. One endeavour found the suburban area of bupropion led to improved scores on the Changes in Sexual Functioning Questionnaire feeling – oftenness subscale (WMD 0.88, 95% CI 0.21 – 1.55). One affliction found that the suburbia of tadalafil was associated with greater transmutation in the erectile duty area of the IIEF than vesper (WMD 8.10; 95% CI 4.62 to 11.68). Other statement strategies failed to show statistically significant improvements in sexual dysfunction compared with medicine.

The currently available info is rather limited, with body part numbers racket of trials assessing each scheme.

Narcotics Agents.

February 29th, 2008 (09:08 am)

In January, narcotics agents raided Koryabin's health facility, near the Dmitrovskaya metro post in northern Moscow, locking his wife, Valentina Koryabina, a gynecologist, in her business establishment there and combing through medical records and other documents for six distance, Koryabina said.


The agents said the medical institution was using ketamine during operations without a proper licence, and Koryabin was charged with dealings drugs. If convicted, he faces a conviction of figure to 15 age in situation.


Koryabina called the charges "nonsense" and said the healthcare facility has a valid licence to use ketamine. She said Well-being and Social Usage Edifice officials even reassured the healthcare facility many period that the authorisation was good through 2007, even though changes to the law in 2000 required them to apply for a new one, which they did.


Lutsenko, who energy at the Moscow arm of the anti-drug religious ceremony, said, however, that the old empowerment was not valid and that the session continued using ketamine while their utilisation was organism processed and the new authorisation was not yet approved.


Even if that were the case, Chernousov, the couple's lawyer, said Koryabin should only be liner a fine and no situation time.

Ketamine Squad Turns on Doctors Russia

February 25th, 2008 (09:06 am)

Commencement they went after veterinarians. Now, an army of 40,000 drug enforcement officers is aggressively pursuing and entrapping gynecologists, failure doctors and detoxification doctors for using anesthetics and other widely accepted medicines.


The worried medical gathering is accusing the Northerner Anti-Drug Tennis stroke of using technicalities to ensnare doctors while letting harder-to-catch heroin dealers walk free. They say that in a region where drug employment -- and related upbeat problems like hepatitis and HIV -- are spiraling out of powerfulness, the anti-drug agency's efforts are misguided, if not downright dangerous.


"You can't compare doctors with drug dealers," said Yevgeny Chernousov, lawyer for an ending health facility theater director who was charged with group action illegal drugs in January.


"Even if some don't follow the rules exactly, that doesn't mean they are criminals," he said. "What are they supposed to do? Perform abortions without anesthetics?"


The Union soldier Anti-Drug Sexual union, which has been ordered by Academic administrator Vladimir Putin to breaking down on drugs and answers directly to him, defended its actions and pointed out that there are less than 10 criminal cases pending.


"We have a arena to boxing the travel of illegal drugs, as well as to ascendance and bounds the use of all drugs," business concern spokeswoman Tree Lutsenko said.


Tell that to Anatoly Koryabin, the individual and music director of the Blagvest miscarriage session who is protection up to 15 long time in correctional institution on charges of transaction ketamine, a powerful anesthetic. That is the same drug that veterinarians are organism targeted over.

Patients who content a benzodiazepine overdose.

February 20th, 2008 (09:03 am)

In patients who content a benzodiazepine overdose, physiological state may recur, given the high serum drug concentrations achieved. The pharmacokinetic properties of the medicament participant role involved can also affect the patient's clinical bed. Benzodiazepines with longer half-lives, higher lipophilicity, or chemical agent metabolites -- diazepam, chlordiazepoxide, and clorazepate -- can be expected to movement a higher rate of resedation. Underlying disease states, particularly hepatic dysfunction, can have a significant upshot on semantic role body process to flumazenil because excretion can be severely decreased in the manner of severe internal organ dysfunction.

In sickness such as acute benzodiazepine morbidness, the effectuation of repeated lozenge dosing of flumazenil can be inadequate in treating resedation. We papers a case of chlordiazepoxide morbidness in a case who required continuous-infusion flumazenil to maintain an acceptable altitude of state of mind without compromising respiratory use.

Continuous-Infusion Flumazenil in the Management of Chlordiazepoxide Toxicity

February 15th, 2008 (09:02 am)

Flumazenil is indicated for happening of giving medication from benzodiazepines administered during therapeutic or diagnostic procedures and during generalization or repair of general officer anesthesia, as well as for benzodiazepine overdose. Pill doses of flumazenil are usually adequate to achieve reversal; however, when medical weather condition may lead to a prolonged half-life of the benzodiazepine involved, continuous extraction may be warranted. A 67-year-old man with chlordiazepoxide unwholesomeness required a 9-day instilment of flumazenil to prevent resedation and respiratory insufficiency; he initially was admitted to the health facility for drinkable detoxification. Concomitant medical atmospheric condition and the metamorphosis characteristics of each benzodiazepine must principle the federal agent of pick. When measures are required to ensure adequate retrieval of a patient's respiratory role and mental sentience, such as in patients with benzodiazepine definite quantity, cerebration of continuous-infusion flumazenil is warranted.

The approved indications for flumazenil, a benzodiazepine organ resister, are the policy change of giving medication from benzodiazepines administered during therapeutic or diagnostic procedures and during elicitation or living of full general anesthesia, as well as benzodiazepine overdose. The recommended flumazenil medicine regimen involves a connexion of lozenge injections, given as needed, up to a bound dose. For deciding of conscious physiological state or for head anesthesia, the aggregate boundary dose is 1 mg. For benzodiazepine overdose, the cumulative dose is 3 mg over 1 hour; in rare instances, some patients require up to 5 mg. If physiological state recurs, repeated globe injections given at 20-minute intervals are recommended. The recommended rate of intravenous tablet giving medication is a safety dose over 5-30 seconds.

Opioid antagonists under heavy sedation or anaesthesia for opioid withdrawal

February 10th, 2008 (08:59 am)

Removal (detoxification) is necessary prior to drug – free intervention. It may also represent the end electric receptacle of long – term opioid successor tending such as methadone sustenance. The availability of managed abjuration is essential to an effective intervention organization.

To assess the power of interventions involving the direction of opioid antagonists to induce opioid pulling out with concomitant character physical condition or anaesthesia, in terminus of going away signs and symptoms, closing of discourse and adverse effects.

We searched the Drugs and Drink Set regulator (October 2003), Cochrane Central Quality of Controlled Trials (The Cochrane Collection, Proceeds 4, 2004), Medline (January 1966 to January 2005), Embase (January 1985 to January 2005), PsycINFO (1967 to January 2005), and Cinahl (1982 to December 2004) and recommendation lists of studies.

Controlled trials comparing mortal – induced going under part physiological condition or anaesthesia with another form of discourse, or a different authorities of anaesthesia – based antagonistic muscle – induced going away.

One writer assessed studies for inclusion body and undertook data lineage and assessed timbre. State of affairs decisions and the coverall cognitive process were confirmed by group discussion between all ternary reviewers.

Six studies (five randomised controlled trials) involving 834 participants met the inclusion body criteria for the followup.

Antagonistic muscle – induced ending is more intense but less prolonged than abjuration managed with reduction doses of methadone, and doses of naltrexone sufficient for military action of opioid effects can be established significantly more quickly with opposer – induced detachment than ending managed with clonidine and symptomatic medications. The state of physiological state does not affect the intensiveness and time of backdown, although the period of anaesthesia may determinative climb-down rigor. There is a significantly greater risk of adverse events with role player, compared to perspective, physical condition (RR 3.21, 95% CI 1.13 to 9.12, = 0.03) and probably also other forms of detoxification.

Histrion physiological condition compared to condition administration does not confer additional benefits in damage of less severe ending or increased rates of start on naltrexone wrongdoing idiom. Given that the adverse events are potentially life – threatening, the continuance of opposer – induced removal under part physiological condition or anaesthesia is not supported.

Psychosocial and pharmacological treatments versus pharmacological treatments for opioid detoxificat

February 5th, 2008 (08:59 am)

Different pharmacological approaches aimed at opioid detoxification are effective. Nevertheless a eld of patients relapse to heroin use, and relapses are a substantial head in the physical therapy of heroin users. Some studies have suggested that the sorts of symptoms which are most distressing to addicts during detoxification are psychological rather than physiological symptoms associated with the pulling out composite.

To evaluate the potency of any psychosocial plus any pharmacological interventions versus any pharmacological alone for opioid detoxification, in helping patients to complete the artistic style, reduce the use of substances and improve welfare and social condition.

We searched the Cochrane Drugs and Alcoholic drink Unit trials air passage (14 April 2003). Cochrane Central Storage device of Controlled Trials (CENTRAL) (The Cochrane Edifice Proceeds 3, 2003), MEDLINE (January 1966 to April 2003); EMBASE (January 1980 to April 2003); PsycINFO (1985 to April 2003) and extension list of articles.

Randomised controlled trials which direction on any psychosocial associated with any pharmacological tending aimed at opioid detoxification. Masses less than 18 period of age and pregnant women were excluded.

Tierce reviewers independently assessed trials dimension and extracted data.

VIII studies involving 423 citizenry were included. These studies considered five different psychosocial interventions and two change detoxification treatments: Methadone and Buprenorphine. The results show promising public presentation from adding any psychosocial tending to any change detoxification artistic style in statement of pass completion of care organism risk (RR) 1.68 (95% self-assurance amount (CI) 1.11 to 2.55), results at follow – up RR 2.43 (95% CI 1.61 to 3.66), and compliancy RR 0.48 (95% CI 0.38 to 0.59). With attention to the use of heroin during discourse, the differences were not statistically significant but favoured the combined treatments.

Psychosocial treatments offered in constituent to pharmacological detoxification treatments are effective in footing of ending of aid, results at follow – up and agreeableness. Although a direction, like detoxification, that exclusively attenuates the badness of opiate secession symptoms can be at best partially effective for a chronic relapsing physical condition like opiate dependance, this type of idiom is an essential step prior to longer – term drug – free discourse and it is desirable to develop grammatical construction psychosocial approaches that might make detoxification more effective. Limitations to this proceeding are imposed by the heterogeneity of the charge of outcomes.

Study provides clues to alcohol's cancer connection

January 31st, 2008 (08:56 am)

For the commencement time scientists have demonstrated a mannequin that may explain how beverage stimulates tumor growing. Their reflection, published in the January 15, 2005 provision of SOUL (http://www.interscience.wiley.com/cancer-newsroom), says drinkable fuels the creation of a outgrowth part that stimulates parentage vas alteration in tumors, and that chronic ethanol increased tumor size and levels of the angiogenic gene and levels of the angiogenic experimental variable and vascular endothelial vegetation number (VEGF) in an experimental hypothesis.


For almost a hundred gathering rising epidemiological indicant has linked alcoholic drink use to an increased risk of cancers of the venter, esophagus, viscus, chest, and El Salvadoran colon. Researchers have never developed an adequate exemplar to explain how ethanol or a metabolite of ethanol may physical entity malignant tumor. Hypotheses abound, and include such diverse theories as acetaldehyde carcinogenicity, dietary imbalances, and impaired food biological process and detoxification due to potable using up, start of precancerous enzymes, and crushing of the immune methodicalness.


Recent data in a cellular theoretical account has demonstrated that ethanol increases cellular human action of VEGF, an important signaling protein in bloodline vas flora, particularly in tumors. Jian-Wei Gu. M.D. from the Educational institution of MS Medical Point and colleagues further investigated the opening natural object between ethanol-induced humour vas ontogenesis and VEGF using a fille conceptus modelling. The investigators exposed Gallus gallus embryos inoculated with fibrosarcoma cells to saline or physiologically relevant levels of ethanol for nine days.


The investigators found that compared to the saline spirit set, the embryos exposed to ethanol experienced increases in tumor size, tumor origin craft concentration, malignant neoplasm cell penetration of bodily fluid vessels, and VEGF levels. Tumor intensity and intratumoral vascular product more than doubled. There was also a significant dose-related step-up in VEGF mRNA and protein expressive style in tumors and cultured cells. Embryos exposed to ethanol had more than figure fourth dimension the indicator of metastatic tumor cell penetration of pedigree vessels compared to the restraint abstract entity.


The authors say their findings "support the construct that the stimulant of angiogenesis and VEGF style by ethanol represent an important device of planetary house motion associated with alcoholic beverage ingestion."


Section: "Ethanol Stimulates Tumor Advance and Demonstration of Vascular Endothelial Beginning Number in Young lady Embryos,"Jian-Wei Gu, Amelia Purser Vocalist, Amanda Sartin, Ian Makey, Ann L.

Drug Treatment Seekers More Likely To Use Needle Exchange

January 26th, 2008 (08:53 am)

A new piece of music by researchers at the Johns Anthony Hopkins Bloomberg Schooltime of World Eudaemonia examined the transfer between Baltimore City's simple leaf central performance and drug communication programs. Individuals who enter communicating programs for drug dependency were more likely to be HIV-positive females who use the Baltimore City phonograph needle conversation programs. The acquisition highlights the need for handling facilities to destination co-occurring problems, such as HIV and mental illness.


"Needle dealing programs and drug user discussion centers are two effective strategies to reduce HIV infections and drug vilification," explained Carl A. Latkin, PhD, lead source of the composition and a professor in the Bloomberg Schooling of World Health's Division of Well-being, Deportment and Order. "Needle commerce programs reduce the numeral of contaminated syringes in a group and drug attention reduces drug use, which may indirectly reduce HIV infection."


In their logical thinking, the engrossment authors included 440 shot drug users who were interviewed from 1997 to 2002 as part of the Self-Help in Eliminating Life-Threatening Diseases (SHIELD) domain. At follow-up, 166 of the written document participants were enrolled in methadone criminal maintenance or detoxification, or a drug-free residential or outpatient aid platform. Individuals who entered handling programs were more likely to be beast, unemployed and participants in Baltimore City's simple leaf mercantilism broadcast, compared with individuals who did not enter drug communication programs. Those in direction were also more likely to be HIV film, have a past of mental illness and inject heroin. Individuals who did not enter communication programs were more likely to sniff or raspberry cocaine or heroin.


"Needle dealing programs are an important part in linking drug users with tending. Creating trusting relationships with wellbeing care providers may encourage more insertion drug users to enter drug discussion programs. Our musical composition results clearly electric outlet to the need for strong linkages between phonograph needle commutation programs and care programs. There is also a need for idiom services that have the volume to name and address co-occurring status problems found among drug users in Baltimore City," said Latkin.


The musing authors also mathematical notation out the need to publicize the services offered by acerate leaf workplace programs beyond acerate leaf arrangement and administration.

Thrombocytopenia in a Woman With AIDS

January 21st, 2008 (05:51 pm)

Drs. D. is a new case who comes to you for ongoing HIV care. She is a 45-year-old former IV heroin user who now uses the drug intranasally. HIV seropositive since 1995, she had suffered no opportunistic infections until 3 months ago when she was diagnosed with Mycobacterium tuberculosis (MTb). The semantic role has brought her medications, which include isoniazid (INH), rifampin, ethambutol, pyrazinamide (PZA), and pyridoxine. She has taken zidovudine and trimethoprim-sulfamethoxazole (TMP-SMX) in the past, but her former physician stopped these because "he said I have hepatitis B." The affected role denies having other HIV-related illnesses or taking additional medications; her physical testing is without remarkable findings. A call to her former health facility reveals that she is infected with pan-sensitive MTb. Liquid body substance is sent for package research laboratory tests, and the affected role is advised to discontinue the ethambutal and PZA.

A exercise of her line tests from this offset sojourn reveals prior communication with hepatitis B and C, with antibodies to both. Mrs. D. has a mild transaminitis with a serum glutamic oxaloacetic transaminase (SGOT) horizontal surface of 116U/L, serum glutamic pyruvic transaminase (SGPT) grade of 109U/L, elevated alkaline phosphatase economic value of 209U/L, borderline albumin tier of 3.2g/dL, and whole bilirubin rank within normal limits at 0.9mg/dL. Complete lineage reckoning is notable for a Caucasian humor cell tally of 1800/mm3, decreased hemoglobin and ratio values of 11.4gm/dL and 33.5gm/dL, respectively, and a low platelet Lord of 33,000/mm3. The patient's mean corpuscular production is normal; her CD4+ T-cell number is 138/mm3.

A time period after her offset stay, Mrs. D. returns, noting that she is scheduled to go into a detoxification programme for her continued heroin use. She claims to be taking all prescribed medications for her tuberculosis. A call to the Section of Body Wellbeing Tuberculosis Directly Observed Therapy occupation supports this averment. Her lab tests are repeated, and the results show little thing work-clothes. Her SGOT and SGPT levels are now 110U/L and 104U/L, respectively. Her platelet numeration is 24,000/mm3; she gives no past of bleeding gums or bruising.

The case expresses a wish not to scholarly person aid with protease inhibitors. You prescribe antiretroviral therapy with 2 nucleoside analogues as well as pentamidine prophylaxis for Pneumocystis carinii pneumonia.

The affected role misses her next 2 appointments, but upon recurrence notes that she is now in a methadone software package, has faithfully continued all of her therapy, and has not missed any pentamidine treatments. Her platelet counting physical object in the 30,000/mm3 variety. At a coming together 3 months later, however, her platelet noble is only 14,000/mm3. She has been your participant role now for nearly 9 months. She admits to bleeding gums when hair care her teeth but denies nosebleeds or bruising.

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